Contact PD/PI: Clark, Robert A. Overall-Abstract San Antonio, positioned at the gateway to South Texas, is the 7th largest US city and the largest metropolitan area with a minority-majority population. Our 38-county region comprises an impoverished, rural, and largely Hispanic population with disproportionate rates of diabetes, obesity, and cancer, exacerbated by lack of health insurance and poor access to care. The region is home to major US military facilities, including the world's largest military medical complex. Service members and veterans form populations with special needs. Neither better access to care nor improved care delivery, on their own, can eliminate health disparities. Innovative translational research is required to fill knowledge gaps and establish real-world effectiveness to improve health. In 2006, UT Health Science Center-San Antonio established the Institute for Integration of Medicine & Science (IIMS) as the academic home for our growing translational science initiatives, training the translational science workforce, formalizing key strategic partnerships, and creating a community of scholars within a learning healthcare system. We expanded clinical research programs, dramatically increasing access to clinical trials. We developed 6 Practice-Based Research Networks that focus on diverse ambulatory populations. We created 6 county-wide Translational Advisory Boards that support engagement through priority setting and matching with academic investigators. IIMS pioneered IRB process harmonization, resulting in rapid review times and streamlined pathways to multisite study initiation. We operate a robust pilot grant program, leveraged among our partners, with a remarkable return on investment. Our workforce development programs, with matriculants reflecting our diverse population, have graduated 133 masters degree students, supported 27 successful KL2 Scholars and 16 TL1 Scholars, and established de novo a Translational Science PhD program. Our informatics team has led electronic health record data warehouse development, fostering matches between IIMS investigators and practice-relevant research priorities. IIMS is now poised to deploy our robust portfolio of programs across our growing, leveraged, and innovative network of institutional and community partners. In this proposal, we provide clear strategies to support clinical and translational science across partner organizations, catalyze research team success, and implement programs that produce creative, collaborative, and culturally diverse translational scientists. IIMS seeks exceptionalism in translating scientific discoveries across the T1 to T4 spectrum into improved health care outcomes. Our over-arching Specific Aims are: 1. Accelerate clinical and translational research innovation and team science along the entire T1 to T4 research spectrum by providing an academic home integrated with our strategic partner institutions 2. Expand, diversify, and enhance the workforce of interdisciplinary translational biomedical scientists 3. Implement effective methods to continuously evaluate and optimize services, increase efficiencies, improve processes, endorse common metrics, and reduce costs across all IIMS programs Project Summary/Abstract Page 237 Contact PD/PI: Clark, Robert A.